PACS:
1. n. (acronym)Picture Archiving and Communications System. A device or group of devices and associated network components designed to store and retrieve medical images.
2. n. (acronym)Pain And Constant Suffering.

Thursday, November 29, 2012

Dalai in RSNA "Wonderland"

For the second year in a row, AuntMinnie.com has allowed me the privilege of substituting my foolish ravings for Mike Cannavo's far more thoughtful and educational RSNA articles. Below you will find my final draft, which was altered slightly by the AuntMinnie editors to be a bit more politically correct. The officially published version can be found here.

Dalai in RSNA Wonderland

or

Dalai in Vendorland

Chapter 1: Down The Scanner BoreDalai was very tired that morning; tired of sitting at his PACS station and getting slammed beyond belief. Twice, he had peeped over to his partner’s stations, but they were lost in conversation, leaving the long list of exams for Dalai.Suddenly there appeared out of nowhere none other than The One and Only PACSMan, wearing a white T-shirt and with eyes bloodshot. “Goombah! I’m late for my scan!” he muttered. Dalai was not generally prone to hallucination, and it later occurred to him that the white-clad PACSMan should not have actually been there in the reading room at that time. But Dalai followed PACSMan's mad dash out of the door to the reading room, down the hall, and into the MRI enclosure. The PACSMan popped into the MRI bore, and disappeared. In another moment, Dalai followed, not stopping to think just how foolish this action might be.The journey down the bore was slow and rather odd. It was quite dark, but here and there could be seen glowing jars of radium, and chest x-rays on old-style viewboxes. Where would this end? Perhaps Dalai would exit another MRI in China, or New Zealand, or maybe in the clinicians’ .05T device across the street. What would Mrs. Dalai think? Probably that Dalai had gone to hike the Appalachian Trail, or was otherwise misbehaving.With no warning, Dalai found himself sprawled on the floor of the Grand Concourse of McCormick Place, having narrowly missed a delegation of sonographers from Japan standing by the Starbucks counter. He spotted the white-shirted PACSMan bouncing down the Concourse, headed for the Technical Exhibits. Dalai tried to follow but was stopped by the guards. “Badge, Please” they croaked. All Dalai had was his radiation monitor badge, but clearly this wasn’t what was needed. Behind him appeared a pedestal with a large red button labelled “Scan Me!” Dalai pressed it, and a warm glow enveloped him, and his tiny radiation monitor had grown into a proper RSNA blue-edged ID . “Only vendors ‘till 10, Doc!” cried the guards. Another pedestal and “Scan Me” button appeared. Dalai pressed this as well. He felt a tingle up his leg, and his badge turned Exhibitor brown. “You may pass!” said the guards, nodding toward the entrance. CHAPTER 2: The Rat RaceDalai wandered into the thick of the Exhibit Hall, and soon encountered a cluster of rather odd-looking black-suited men, milling about the various technical displays in more or less circular fashion. “Whatever are you doing?” asked Dalai timidly.“Why my good man, we are running the Imaging Sales Rat Race!” said the first of the gentlemen. “It serves no purpose, we end up where we began, but we look busy and everyone gets a prize. Did you bring one for all of us?”“Um..well, I only have my iPhone,” mumbled Dalai. “Hand it over. We’ll use it to place orders for all of our modalities, and everyone wins!”The dark-suited man grabbed for Dalai’s phone. “Patience! First, we must....” Dalai cried. “Yes, Dalai! Patients First! The patients deserve the best of the scanners, which you cheap doctors seem loath to provide!”“I didn’t mean it that way! It’s Administration’s fault! They HATE spending money and salesmen too! And they want to comply with the Laws, known and unknown! But of course for me, Patients come First! Don’t be so easily offended!”And with that, the odd men got up and resumed their circular trek. Chapter 3: The PACSMan Gets a Little BillThe white-clad PACSMan reappeared, rounding a corner behind a huge display of bone-containing plastic phantoms. He looked straight at Dalai, and howled: “My Bill! My Bill! this is outrageous! $5,725 to look in my head? I’ll have someone bumped off, I will! Get going buddy, right now! Leave the scan, bring the cannolli!"“He thinks I’m his personal radiologist,” Dalai thought to himself. “Patients First”, yes, but really...Another pedestal arose with another button labeled “Scan Me!” Dalai pushed it, and this time felt a migrating itch travel from head to toe. His badge turned green, the RSNA color of important people who are not physicians. As he was unable, and, by virtue of the new badge unqualified, to fix the PACSMan’s Bill, Dalai was able to escape to the next booth.Chapter 4: Advice from Aunt MinnieDalai’s flight took him to a booth containing several plush leather motorized massage chairs. In the last was seated a little old lady, smoking a Cuban cigar. “Who are YOU?” she cackled.“I’m not quite sure anymore,” said Dalai rather hesitantly. “I was once a radiologist, but I seem to have become a number of other things. I started out trying to care for Patients First, but now I seem to have to please everyone! I have to fix Bills and such. I’m not sure I even remember what FEGNOMASHIC stands for.”“Repeat it for me, Sonny!”“OK, if you insist...Fibrous Dispepsia, Elusive Granuloma, Generic.....”“Wrong! Wrong from beginning to end!” She puffed the cigar for a moment. “So if you don’t know who you are, why do you think you are a radiologist? Why can’t you go with whatever you are now? Like they say, if it looks like your Aunt Minnie, sounds like your Aunt Minnie, it’s your Aunt Minnie. That’s me, Dalai!” And she cackled some more. “By the way, Sonny, if you push that button behind you, you’ll turn into something else entirely, since you don’t know who you are anyway. Neither looking or sounding like a duck, eh? Push it and get outta here!”Dalai looked and there was yet another pedestal and red button, although it lacked the “scan me” label. He pushed it, experienced a transient rash across his torso, and his badge turned red for a non-member physician.Chapter 5: Cheshire CAT-ScannerThe next booth over was the home of the Cheshire CAT-Scanner. Dalai walked up to the massive device, which had a huge display panel on top. “What shall I do, dear Scanner?” “It depends on what you wish to accomplish,” scrolled across the display.“I don’t care much at this point. I just want to scan gently, and put my Patients First.”“Then it doesn’t matter much where you go on the exhibit floor...they all do the same thing. Except for this!”And with that, the Scanner faded from view, with only the flashing alphanumeric display still visible. “You’ve come to an area of unreality, of madness. The real world doesn’t work this way, Dalai, and now you’re mad too. You must be, or you wouldn’t have come here.”“And you know I’m mad how?”The scanner faded back into solidity. “Look at me. I can scan the entire volume of a patient in 0.066 seconds, and rather than irradiate the patient, I draw radioactivity FROM the body. They patient leaves my gantry with less dose than when he arrived. Yes? Since you believe every bit of the hype you see around you when you come to the exhibit floor, you are therefore mad. Now do you wish to play footsie with the King and Queen today?”“I don’t think I would,” demurred Dalai.“Too bad,” said the Cheshire CAT-Scanner silently...you’re booked for One in the Afternoon at the Palace. But you need to have a bit of a chat with the Vendors first.” And with that, the scanner vanished from the booth. A new pedestal appeared in its place, with the familiar “Scan Me” button. Dalai shrugged, and pressed it.Chapter 6: The Mad Vendor’s Cappuccino PartyWith a sudden, brief attack of GERD, and the conversion of his badge back to blue, the color of full members of RSNA, Dalai walked down to a very large booth, finding a lovely Danish Modern dining room table and chairs placed directly in front of a huge brass espresso machine. Several dark-suited types were scattered about the table, with one wearing a meatball-splotched tie.“Have some cappuccino, Dalai,” said one of the diners.“But we’re out of cappuccino!” said another.“Hey Dalai,” said the man with the tie, “How do you qualify for Meaningful Use?”“I believe I can guess that,” responded Dalai.“Do you mean that you think you can find out the answer to it?” said another dark-suit.“Exactly so,” said Dalai. “It’s simple, really, isn’t it? But wait...what’s Meaningful Use anyway?”“You mean you don’t know?” cried the Mad Vendor. “Darn. Neither do we. But that won’t stop us from trying to sell it to you!” And the dark-suited men began to bicker amongst themselves, telling stories of customers that got away.Dalai got up and left the table, ultimately exiting the madness of McCormick altogether, and wandered south.Chapter 7: Nothing's Cricket in Hyde ParkAfter walking quite a distance, Dalai found himself in a quaint, tree-lined neighborhood, with one house that stood out, clearly a palace. The King and Queen themselves were inside, sitting on matching thrones. They were incredibly angry, calling out, “Off with your revenue! Decapitate your capitation!” Sprawled before the thrones were a dozen other radiologists, just as confused as Dalai by the whole proceeding.“Patients First!” bellowed the King. “You tried to steal the revenue! Call the witnesses!”The Mad Vendor approached the dais. “I tried to get them to participate in Meaningful Use! But they wouldn’t buy my wares. I’m a poor man, your Majesty, and a very poor salesman.” “And a very poor speaker. But you tried to put Patients First. Stand down.”“But your Majesty, I’m already on the floor as it is!”“Then SIT down!”The assembled courtiers snickered in delight.“Call Dalai to the stand!”Dalai approached with hesitation, but then stood straight though with head bowed.“What do YOU know of this business?” asked the King, and the Queen nodded, sure of what was to come.“Why, nothing, your Majesty. I’ve always tried to put Patients First, but to no avail. With the coming cuts and payment shifts, we radiologists can’t serve them as we once did. And no one knows how radiologists might participate in Meaningful Use!” “Matters not,” said the King. “If they cannot transmit Patient Data to Us, they are not worthy. Haven’t they signed the Meaningful Use Attestation?”“No, your Majesty.”“Aha! All of you must have meant some mischief, or else you’d have signed your names like honest men! Off with their revenue! Decapitate their capitation!” Chapter 8: Back HomeDalai sat up with a start, and looked around at his reading room, to which he had returned from his rather bad daydream. His colleagues were still locked in conversation, and the list had grown to gargantuan proportions. He picked up the microphone, put it down again, got up, and walked out of the hospital. The other rads eventually discovered his absence, after receiving several frantic calls from the Emergency Department inquiring after reports. They realized what had happened, although Dalai’s trip to Vendorland and Hyde Park could never be known to them. Still, they longed for the simple life when Patients really did come First. The End